Effect of re-transfusion systems on physiotherapy participation and transfusion in total knee joint arthroplasty

Total knee joint arthroplasty is associated with significant blood loss. We hypothesized that re-transfusion drains would be associated with a lesser requirement for allogeneic blood transfusion and result in earlier physiotherapy participation and decreased length of hospital stay.

We performed a retrospective analysis of 303 patients with a mean age of 68.3 years (44-91) who underwent unilateral primary total knee joint arthroplasty within a single orthopaedic unit. A re-transfusion drain, deep drain, superficial drain or no drain was placed at the time of surgery. Blood tests were taken pre- and post-operatively, and blood transfusions were given based on the haemoglobin and clinical symptoms. Medical records data were used to determine the day patients sat out of bed, mobilized more than 10 m and were discharged from hospital.

Patients with a re-transfusion drain were able to sit out of bed (P = 0.006), mobilize more than 10 m (P = 0.006) and were ready for discharge earlier (P = 0.013) than those without a re-transfusion drain. The use of a re-transfusion drain showed no effect on allogenic blood transfusion requirement; however, it was associated with decreased haemoglobin drop when compared with other drain types (P = 0.003).

Our results suggest that the use of a re-transfusion system following total knee arthroplasty has beneficial physiotherapy outcomes and a decreased length of stay.